Permit + CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00799
e a, i DEVELOPMENT SERVICES DATE ISSUED: 12/14/2004
II 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S102CC -01100
SITE ADDRESS: 13680 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description:
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMPIIRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 1 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD LODGE #207 RED HILLS ELECTRIC & TOWER SERVICES
PO BOX 230184 PO BOX 490
TIGARD, OR 97281 DUNDEE, OR 97115
Phone: 503 - 625 -4084 Phone: 503 - 554 -8244
Reg #: LIC 134593
SUP 4390S
FEES ELE 36 -84C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/14/200' $86.95
[TAX] 8% State Surcharge 12/14/200' $6.96 Rough -in
Elect'I Final
Total $93.91
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
J
Issued By: Permit Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
' CONTRACT •� INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: GU // ' DATE: / / /�/�O�
LICENSE NO: 6l ?9 s
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Pernn ■,1 i. ED FOR 0FF1c1.: I SE OM
City of Tigard Received
Review ed Permit No.:
13125 SW Hall Blvd., q , Tigard, O1I9 231 4 LOO4 v fU �Oa7
Phone: 503.639.4171 Fax: 50 8.1960 '% '+ 1 DDate/ft . Other Permit:
Inspection Line: 503.639.4175 '� �� Date ReadyBy aims: See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TI V O NNotified/Method: T ®
Supplemental Information
BUILDING D
TYPE OF WORK PLAN REVIEW
a lgew construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'I ❑Hazardous location
El Service over 320 amps - rating DBuildng over 10,000 sq. ft.,
CATE , t RY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling in Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other; ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or •
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
n ❑Health -care facility ❑der:
Job no.: Job site address: 13Gp.D $ UJ p r ; '} a I J Submit 2 sets of plans with any of the above.
City/State/Z1P: �� j The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt no.: Project name: ?- UQ,1,s— Description I Qty. I Fee. I Tam I ..
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. R or less 145.15 4
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less / 80.30 e� 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
. Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
(
service or feeder fee, each �2
Business name: c < .: l,,. / � - LSGae _ ........,..._<._ branch circuit / 6.65
B. Fee for branch circuits
Contact name: " 1 ( p., Lrfri without service or feeder fee, 46.85 2
Address: ( goX y9 O each branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: 1 �� Q �� C) q i 7i i s Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (6),3) .... 4-4/... 02 47/4 I Fax: : C5 _5.4 _ / 7 .74, Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: .-'#1 > „4.6u,,,,._
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: _Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: ( ) Fax: ( ) • ELECTRICAL PERMIT FEES*
CCB Lic.: J 3U4 I Electrical Lic.: 3G_gNc Suprv. Lic.: e./3. y S Subtotal
Suprv. Electrician signature, required: � // _ Plan review (25% of permit fee)
r Y / Date. -
State surcharge (8% of permit fee)
Print name:
��� // R / ` TOTAL PERMIT FEE
signature: Authorized si / , ,,, 1. ss „ /( ", , _ / This permit application expires if a permit is not obtained within 180
i "'�/ days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
iABuitding \Pcsmits\ELC- PamitApp.doc 12/03 410.46t5T(10102/COM/WFB
Electrical Permit Application - City of Tigard -,
•
Page 2 - Supplemental Information
. LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined........ . $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system. $75.00
(SEE OAR 918 260 - 260) •
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems -
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
•
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ BuildingWmmib\F1.C- PamitApp.doc 04/03
CITY OF TIGARD 24 -Hou
BUILDING Inspec e: (503) 639 - 4175
INSPECTION DIVISION Business Line: (503) 639 - T1 MST
�(f� BUP
Received Date Requested ° AM� PM BUP
Location R61 r l� Suite MEC
Contact Person N Ph ( ) 762 - rq PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing •
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
R Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
FAIL
I CAL
Rough -In
UG/Slab
Low Voltage
Fire Alarm
41Crlk ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line ✓ G,
ADA
Approach/Sidewalk Dat a - � Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL